PB2685: QUALITY OF LIFE IN INDIAN ADULTS WITH IMMUNE THROMBOCYTOPENIA
Authors: Vivek Bhat, Dhwani Ravi, Samudyata Satish, Chaitanya H Balakrishnan, Tiji Alphonse, Cecil Ross, Sanjukta S Rao, Seetharam Anandram
Journal: HemaSphere (2023)

Topic: 35. Quality of life and palliative care Background: Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder characterized by the destruction and impaired production of platelets. Patients commonly have impaired quality of life (QOL), due to factors inherent to the disease, as well as the therapies needed to treat it. Recent guidelines have emphasized the need to consider QOL in clinical decision-making. Yet, there remains a paucity of information regarding QOL in ITP from the Indian subcontinent. Aims: This study aimed to assess the QOL and the factors affecting QOL of adult patients with ITP at a tertiary care center in South India. Methods: We included all adult patients (>18 years old) diagnosed with ITP, presenting to our center, from June to December 2022. After obtaining informed consent, we collected demographic details and administered the ITP-Patient Assessment Questionnaire (ITP-PAQ) in the patient’s language of choice. This is a validated questionnaire consisting of six broad domains with a total of 44 questions - physical health (PH - 15 questions), emotional health (EH – 10 questions), social activity (SA - 4 questions), overall lifestyle (OL - 5 questions), work (W - 4 questions), and finally, reproductive health for women alone (WRH - 6 questions). Each question was scored using a four-to-seven point Likert scale, and each domain was scored from 1 to 100, with a lower score implying a worse QOL. We considered a score of <75 as poor QOL, and <60 as very poor QOL. We then carried out the independent t-test between different subgroups to determine factors associated with poor QOL, taking a p-value of <0.05 as statistically significant. Results: We included 59 patients, with 44 (74.6%) being female. The mean (SD) age was 39 (11.9) years. 48 (81.4%) had chronic or persistent ITP, with 28 (47.5%) receiving more than two different therapies since their diagnosis. The median (IQR) platelet count at the time of assessment was 46,000/mm3 (23000, 122500). The mean (SD) total QOL score was 70.2 (14.1). 36 (61.0%) reported poor, and 15 (25.4%) reported very poor QOL. Mean domain scores were as follows - 72.1 (PH), 70.4 (EH), 71.2 (SA), 57.7 (OL), 67.5 (W), and 81.4 (WRH). Males had worse QOL, though not statistically significant (p=0.057), while patients with >1 admission for ITP-related complications had significantly worse QOL (p=0.036). There was no significant association of low QOL with age, education, income level, type of ITP, or current platelet count (Figure 1). Summary/Conclusion: Our study provides a valuable, quantitative estimate of the QOL in Indian adults with ITP. We found that QOL is poor in these patients, particularly with regard to overall lifestyle and work. Male patients, and those with multiple inpatient admissions slightly worse QOL. Clinicians must be cognizant of impaired QOL while caring for these patients and tailor their therapeutic approach appropriately.Keywords: Quality of life, ITP, Immune thrombocytopenia (ITP)